Educational Exhibit Abstract No. 246 - An elective hybrid suite approach to the management of placenta accreta-associated postpartum hemorrhage (PPH)

Abstract

Learning Objectives 1. Define placenta accreta and the clinical relevance of early diagnosis. 2. Describe the multimodality imaging appearance of placenta accreta. 3. Outline the role of the interventional radiologists in the management of placenta-accreta associated PPH. 4. Describe a novel hyrbid suite approach for the collaborative elective management of placenta accreta-associated PPH. Background Postpartum hemorrhage (PPH) is an obstetric emergency associated with significant morbidity and mortality, representing a major indication for emergent hysterectomy. Placenta accreta is a significant cause of PPH, with an increasing frequency in the US secondary to the increased incidence of cesarean section. Interventional radiologists play an important and expanding role in the management of PPH. Post-partum uterine artery embolization (UAE) has a reported clinical success of 79-97%, with a demonstrated decrease in morbidity and mortality. Clinical Findings/Procedure Details The elective staged management of accreta-associated PPH involves the use of a hybrid IR/OR suite. Occlusion balloons are placed into bilateral IIA/anterior division through bilateral groin accesses and remain deflated. Cesarean section is performed in the hybrid suite followed by immediate balloon inflation. Coaxially through the occlusion balloon a micocatheter is used to selectively embolize bilateral uterine arteries and anterior division branches supplying the placenta using standard techniques. Hysterectomy is then performed by the gynecology team. The balloons are deflated and “second look” angiogram is performed as needed prior to fascial closure. Conclusion and/or Teaching Points 1. Placenta-accreta associated PPH is increasing in incidence with significant associated morbidity and mortality. 2. Post-partum UAE has been shown to decrease PPH-associated morbidity and mortality. 3. Collaborative elective staged cesarean section in a hybrid IR/OR suite is a technically feasible approach in the management of placenta accreta and may be associated with a decrease in blood product requirement, hospital stay, and maternal morbidity.